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Did wink provoke brutal assault?

By Alicia Gallegos
Tribune Staff Writer

Thursday,April 5, 2007
Edition: MARS, Section: nation, Page A1

SOUTH BEND — Hazel Salinas remembers tearfully looking down at her fiancee Jose Contretras last week before he was whisked away into surgery.

The beating Contretras allegedly suffered at the hands of a co-worker had cracked his skull, doctors told them, causing bits of bone to lodge in his brain.

The sight of dried blood covering the man’s clothes lingered in her mind as she waited for word on his condition, she recalled Wednesday.

Amazingly, Contretras improved dramatically after doctors removed the particles and closed his skull. He was able to return home this week.

Despite relief that her fiancee is mending from the near-death experience, Salinas and her friends say they’re angry that his accused assailant already is back on the streets.

James Hinkle, 54, was charged with two counts of class C felony battery of Contretras while the two were at work Friday.

Hinkle was out of jail the day after the incident on $1,000 bond, according to jail records.

Hinkle told police he hit Contretras with a metal pole because he was annoying him, according to police reports, but Contretras said through a translator Wednesday that he had done nothing to the man.

Salinas believes the beating may have been racially motivated, and she believes Hinkle should face a stiffer penalty considering the extent of Contretras’ injuries.

“He could’ve killed him,” Salinas said during an interview at her home. “Even if he was winking his eye, is that cause for somebody to try to kill somebody?”

Police said Wednesday they have no reason to believe the incident was race-related.

The incident allegedly took place Friday afternoon at AJ Wright, 1902 West Sample St., as Hinkle and Contretras were unloading trailers.

Police reports indicate that Contretras had been “blinking his eyes” at Hinkle and “making kissing gestures,” which irritated the man.

Hinkle reportedly told another co-worker that he was going to hit Contretras if he didn’t stop. Shortly afterward, he allegedly attacked Contretras with the metal rod.

Employees Debbie Brocklehurst and her daughter Kathy Hollingsworth ran to Contretras’ aid as soon as they saw him lying on the ground.

“He wasn’t moving,” Brocklehurst remembered by phone Wednesday. “There was a lot of blood.”

Both women were shocked that Hinkle would strike the man for no apparent reason.

Because of the language barrier, Brocklehurst said Contretras often whistled and used hand signs to communicate with workers who didn’t speak Spanish.

Brocklehurst said it was just his way of communicating and no one else seemed to mind.

Contretras said Wednesday that he had never interacted with Hinkle before and that he doesn’t remember exactly what happened.

“I’m mad, ’cause I didn’t do anything to him,” he said. “I didn’t even talk to him.”

In response to a question about whether the suspect’s actions may have been racially motivated and constituted a “hate crime,” a statement released by the St. Joseph County Prosecutor’s office Wednesday states:

“There is no Indiana Criminal Statute that exists that designates a racially motivated crime as a separate offense, nor is there any Indiana Statute that enhances or aggravates an existing criminal offense or its penalties if the criminal activity is racially motivated.”

A spokeswoman for AJ Wright would not comment on the incident Wednesday.

She also said she could not confirm or deny if Hinkle still was employed by the company because it was a “police matter.”

Salinas said she was told by administrators that Hinkle no longer worked for the company.

Meanwhile, Salinas is doing her best to care for Contretras, who needed more than 13 staples to close a 7-inch gash in his head.

Contretras should make a full recovery, Salinas said, although he will have to undergo more surgery. The couple had been planning to get married later this month but had to postpone the wedding.

Right now, both said the biggest question on their minds is “why.”

“I want to know why he did this to me,” Contretras said. “He did not have (any) reason.”

Staff writer Alicia Gallegos:

agallegos@sbtinfo.com



Silent, naked and alone

By Alicia Gallegos
Tribune Staff Writer

Wednesday,February 22, 2006
Edition: LOCL, Section: nation, Page A1

Fourth of six parts

Grainy video footage shows a scrawny man with a shaggy beard and greasy hair surrounded by trash in his tiny, stark room.

The inmate is lying on his jail bunk, wrapped only in a beige blanket, and unmoving when the guards rouse him. A jailer waves her hand in front of her face, trying to fan away the odor as another guard approaches the man. “Come on, Nick, time for a shower.”

Jailers had resorted to filming Nicholas Rice in the spring of 2004.

A jail e-mail dated April 15 explained that recording the situation might finally drive the point home.

“What I need from everyone is documentation relating to this subject no matter how big or small it may be,” wrote Lt. Fred Call. “I’m attempting to work with the public (defender’s) office to show this person (may) need help.”

Jail Capt. Brad Rogers says now that Nicholas’ mental state concerned the staff.

After repeated attempts to coax Nicholas out of his cell, jailers eventually lift him naked from his bed, put him in a restraint chair and wheel him toward the showers.

“Help us out, bud,” a guard tells Nicholas during one filming. “Stand up and go into the shower,” another says. “Rice? Please? Can you do that please?”

But Nicholas doesn’t respond. Guards covered by black plastic bags place him under the water and wash him by hand, scrubbing his hair and soaping his back.

The skinny inmate says nothing and limply allows jailers to bathe him.

***

Despite a past diagnosis of schizophrenia, a judge found Nicholas competent to stand trial in June 2004, setting his trial for December. The court order by Elkhart Circuit Court Judge Terry C. Shewmaker cited two earlier evaluations that found Nicholas competent and indicated that he was likely pretending.

Shewmaker declined to comment about the case.

Nicholas’ public defender later explained it was these first evaluations that distorted the view of his client and prevented him from getting help.

“Our system is one here that (the court) tends to rely on mental evaluations by court-appointed psychiatrists,” R. Brent Zook says. The assessments “present a rather mixed image.”

Nicholas was eventually moved to a lockdown area at the facility inmates called “the hole.” In the segregated area, inmates had to stay inside their cell for 23 hours a day with one voluntary hour spent in a jail dayroom.

The single cell was for his own safety, the jail captain later told Nicholas’ dad.

Other inmates disliked Nicholas, says former inmate Jeremy Miller, who was housed next to Nicholas. In some videotaped scenes, inmates jeer and taunt the silent inmate, yelling obscenities as guards open his cell door.

During Miller’s hour out he would try to talk to his neighbor, offering him a Halls lozenge through the bars of his cell. Halls were the closest thing to candy for inmates. Sometimes Nicholas would take the “candy,” but mostly he made incoherent noises, Miller remembers.

On one occasion, Nicholas was standing in front of his toilet without any clothes on when another inmate pushed a broom handle through the bars and jabbed him. Officers discovered the man assaulting Nicholas, but not before he’d struck him multiple times. Golfball-sized red welts covered Nicholas’ body, video footage shows.

Rick Rice was later told his son just stood there as the inmate attacked him.

***

Fellow inmates weren’t sure why Nicholas was ever allowed the razor. Everyone knew the naked inmate didn’t shave.

But one day in early August, shortly after his 22nd birthday, he was handed a blade as guards were passing them out.

The inmate sliced open his own neck.

Jail staff found Nicholas standing in his cell holding the right side of his neck with a towel and covered in blood, according to a jail log. The wound was over his carotid artery and about an inch long. After three stitches at the hospital, Nicholas returned to the jail the same day. Eventually, he was put back inside his single cell in Ward 1.

***

Near the end of August, Rick tried to visit his son, and for once, Nicholas came out of his cell. But he wouldn’t speak. The inmate walked out into the visiting room and stood there for less than a minute, his father remembers, before retreating back down the hall.

Rick watched as his son began to fall into a wall and a guard quickly grabbed his arm to steady him.

***

After more than a year of rejecting food, Nicholas’ ribs visibly protruded from his sides, his lanky arms revealed no muscle mass, and his legs were thin and bony.

Jail psychiatrist Bryce Rohrer wrote that Nicholas had lost almost 50 pounds since he arrived at the Elkhart County Jail.

The skeletal inmate was taken to a hospital emergency room on Oct. 5, 2004, after being court-issued a 72-hour commitment for medical and psychiatric treatment in a secure facility.

“Patient is dying from malnourishment,” jail psychiatrist Bryce Rohrer, wrote in Nicholas’ application for emergency detention. “Also has significant psychiatric problem. Applicant believes that if the person named above is not restrained immediately he will die.”

In capital letters, the doctor added, “NEED COURT ORDER TO ADMINISTER FOOD AND MEDICATION.”

Rohrer declined to comment for this story.

When officers took Nicholas to Goshen General Hospital that afternoon, they intended to drop him off and leave, according to nursing notes, but staff informed them it was against hospital policy to have an incarcerated patient there without jail supervision.

The problem circled into a lengthy conversation between medical staff and jailers.

3:30 p.m. Goshen General Hospital notes: “The police officers called their sergeant and they were told to bring patient back because they didn’t have the manpower to leave two officers in the hospital (with) the patient.”

4 p.m. jail log entry: “All the Elkhart County Sheriff’s Department wanted was for inmate to be taken care of medically and in the event that he is combative or dangerous (they) were to call immediately and an officer would be available.”

4:30 p.m. jail log entry: “(Hospital legal counsel) called and had concerns about her staff maybe becoming injured” if handcuffs are removed. “I informed her that we did have another judge’s order and I would fax it to her.”

5 p.m. hospital nursing notes: “Police officer leaving. Security called for patient to be watched when officer leaves.”

5:15 p.m. nursing notes: “Patient pulled out IV, out of bed. Security officer called for more assistance. Four extra people here to help.”

6:55 p.m. jail log: “Called Capt. Rogers and they are leaving an officer with inmate at least until tomorrow.”

Although it was recorded in jail notes that Nicholas was to go to Oaklawn, a psychiatric facility, after he was stabilized, a physician who called the facility was told they wouldn’t accept him.

He spoke to Salvador Ciniceros, according to hospital notes, a doctor who had done a previous court-appointed evaluation. He told the caller the facility would not take him because on a previous admission, Nicholas was found to be malingering.

After less than 24 hours at the hospital, Nicholas was back inside his cell.

***

As Nicholas’ trial edged closer, a gleam of hope finally broke through.

Zook and chief deputy prosecuting attorney Vicki Becker both agreed to have Nicholas evaluated again.The prosecution came to the agreement after some comments about Nicholas’ behavior from witnesses involved in the bank robbery attempt, Becker recalls. “We believed it deserved the necessary evaluation of mental capacity.”

On Dec. 6, 2004, Judge Shewmaker signed an order delaying his proceedings and committing him to the State of Indiana Division of Mental Health.

The paperwork was on its way to Logansport State Hospital, and it was just a matter of time until a bed became available.

Coming Thursday: ‘Can I go home now?’

New lead-safe rule in effect

By Alicia Gallegos
Tribune Staff Writer

Source: news
Monday,April 26, 2010
Edition: mich, , Page B1

SOUTH BEND — A new federal rule aimed at lead-safe practices in older buildings could soon find contractors ill-prepared to implement the changes.

The new Environmental Protection Agency regulation, called the Renovation, Repair and Painting rule — which went into effect Thursday — requires all renovators working on homes built before 1978 to complete lead-safe practice training and certification.

But local health department officials are concerned that not enough contractors have yet been trained.

“I don’t feel as if there is a lot of awareness (of the rule),” said Megan Wright, Healthy Homes coordinator for the St. Joseph County Health Department.

Wright said the EPA was a bit slow in pushing awareness of the rule and that a lack of lead-safety trainers has led to the dilemma. According to national reports, some trade associations have alleged that fewer than 14,000 contractors have been trained thus far.

Meanwhile, the EPA has reported that more than 50,000 contractors already have been certified across the country and they expected an additional 100,000 would be approved by Thursday’s due date.

Wright is hoping that more local contractors jump on board with training, or at least start the approval process by submitting the correct form and fee.

Much of St. Joseph County will be affected by the rule, Wright said, considering almost 80 percent of housing stock in the county was built before 1978.

She adds that the rule doesn’t just apply to houses.

The new regulation specifies anyone working on homes, apartments or children-occupied facilities such as child-care centers must take an eight-hour training course and receive the approved certification. Individuals as well as firms are required to have the new credentials in order to continue operating.

Violations could result in a fine of more than $30,000 by the EPA.

Ron Perry, a contractor with the Robert Henry Corp. in South Bend who recently had the lead training, said he understands the positive effect of the rule, but he wonders about the extra cost to each job.

Alan Loeffelholz, a contractor with VanOberberghe Builders in South Bend, who also recently had the training, agreed.

“Hours are money,” he said.

Contractor Brian Burris, however, argues the new changes will not affect time and work as much as some contractors might think.

Burris, a contractor with B&E Remodeling in Mishawaka, had an intensive course in lead-safe practice training a few years ago and noted the practices only take some getting used to at the beginning.

“We contractors, we hate being told what to do,” Burris said with a laugh. “We hate change. But it seems a whole lot worse than it is.”

Supply costs for the new rule vary, with some estimates being as low as $100. Burris said the cost is more like $1,000, but that after the initial expense the cost levels off. He added the main part of the training relates to containing the work area, minimizing dust and cleaning up thoroughly.

The process take more time at the start, Burris said, but the cleanup is actually easier.

“With kids that do get so sick, it’s far worth it,” Burris said.

Health advocates agree the new rule could potentially save many children from being poisoned.

“This is long overdue and should substantially reduce the number of lead-poisoned children,” health department environmental manager Marc Nelson said in an e-mail.

Nelson pointed out that the Occupational Safety and Health Administration has historically had policies to protect people who perform work that disturbs lead, but no real protection has been provided to people actually living in the home until now.

Lead dust in homes, Wright adds, is the main source of childhood lead poisoning.

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

Law could mean pool closures

By Alicia Gallegos
Tribune Staff Writer
Source:  news
Sunday,December 21, 2008
Edition: mars, , Page B1

SOUTH BEND — With frigid temperatures outside and a constant serving of fresh snow on the ground, the thought of swimming pools is the farthest thing from most people’s minds.

But with a strict new law that went into effect last week on proper drain covers for all public pools — including high schools and recreational centers — pools have become a hot topic despite the cold climate.

The Virginia Graeme Baker Pool and Spa Safety Act was signed into law last year and is designed to prevent drain entrapments and eviscerations that have taken the lives of many children over the last few years.

The law is named for a 7-year-old Virginia girl who drowned after being held underwater by a family friend’s spa drain.

But officials with the U.S. Consumer Product Safety Commission said last week that a significant number of pools and spas across the country have not yet met the regulations and were at risk of being shut down by last Friday.

“We are concerned about the level of compliance as we come upon the deadline,” CPSC spokesman Scott Wolfson said last week. “It’s a federal law that should not be ignored.”

New drain availability and cost, however, are two factors prohibiting some compliance, operators say.

At the YMCA of Michiana, aquatics director Amy Milliman said the facility’s older model pool requires drain covers specially made to fit the size and shape of the pool. Right now, staff must wait until drain covers are built and shipped, she said.

Milliman added that although the law was passed last year, information was slow and then unclear as it reached pool operators. The regulations had two drafts, she said, the second being much stricter than the first.

“I’ve been told that we do meet the requirements; I’ve been told that we don’t meet the requirements,” she said. “It’s very confusing.”

Other facilities currently in operation also will be affected by the new law, such as hotel hot tubs and pools.

The Marriott in South Bend is one hotel that seems ahead of the curve when it comes to the new regulations, having had new drain covers on their pool and hot tub for nearly a year, said director of operations Kelly Neubauer.

The Marriott corporation was proactive in making sure all its hotels were in compliance, Neubauer said.

At least 10 other calls to local hotels were either not returned Wednesday or a reporter was told no one was available to speak about the drain issue.

At local schools, availability also seems to be a problem.

Penn-Harris-Madison School Corp. is working with an Indianapolis company to make new drain covers for the pool at Penn High School, according to spokeswoman Teresa Carroll.

“We are moving on that,” she said. “However, they do not have the products available.”

Likewise at Mishawaka schools, athletic director Bob Shriner said he was checking with supply companies on availability.

He noted, however, that larger pools such as ones used by swim teams have multiple drains and do not pose the same suction hazards that smaller pools and spas do.

Wolfson from the safety commission stressed it’s up to state and local officials to enforce the new law.

St. Joseph County Health Department officers will make note of the new drain covers or lack thereof during pool inspections, according to food supervisor Rita Hooton, but that at this time they can’t enforce the rule.

The health department has to wait until the state has adopted the new regulation into state law, she said, which officials are now in the process of doing.

To learn more

For more information about the Pool and Spa Safety Act, how to comply and which companies have been certified to manufacturer drain covers, go to http://www.cpsc.gov.

Psychiatry facing challenges

By Alicia Gallegos
Tribune Staff Writer

Source: news
Monday,April 19, 2010
Edition: mich, , Page A1

When Dr. Alan Schmetzer graduated from medical school in the early 1970s, the psychiatrist saw significant opportunities for young professionals in the mental health field.

At the time, the Indiana University School of Medicine in Indianapolis — where Schmetzer currently teaches — had 12 open spots for psychiatry residents, which in turn was leading to a host of new community mental health centers opening.

Today, Schmetzer says that landscape has vastly changed. Numbers of open spots for future psychiatrists at IU and other schools have dropped by nearly half, according to the doctor, and many community health centers across Indiana are struggling financially.

Most recently, Madison Center in South Bend has had to cut positions and undergo significant restructuring under growing pressure from creditors.

To offset spaces left by resigning physicians, the local mental health facility says it plans to hire an undetermined number of temporary doctors called “locum tenens”

until they can fill full-time slots.”This is happening all over the country,” Schmetzer says of the reductions. “(But) the Midwest in particular is very short of psychiatrists.”

Indiana has some of the poorest psychiatrist rates per capita in the nation, according to Schmetzer, and the state is no stranger to financial troubles forcing mergers and shutting down mental health facilities.

Some experts have hypothesized that in the next 10 years, the number of community mental health centers in Indiana will be down to five mega-centers.

The theory is one that doctors like Schmetzer hopes never becomes reality.

Need vs. growth

Psychiatrists have long lagged behind their physician counterparts in terms of numbers, but recently doctors say that gap has extended even further.

Whether it’s more mental illness among the population or more awareness of mental illnesses, Dr. Jess Shatkin says diagnosis of conditions such as bipolar disorder and autism have increased 40-fold in the last few years.

Shatkin, director of education and training at the New York University Child Study Center and director of undergraduate studies for the Child and Adolescent Mental Health Studies, says this rise in need has put a strain on an already thin discipline.

A recent study on mental health care workers in Health Affairs magazine, for example, showed that between 1990 and 1999, the number of psychiatrists in the United States increased by only 15.2 percent, compared with a 37 percent increase in psychologists and a 17.9 percent increase in social workers.

Certain realms inside psychiatry are even more underserved, specifically child psychiatry, says Dr. Harsh K. Trivedi, executive medical director of Vanderbilt Psychiatric Hospital in Tennessee.

Trivedi says about 7,000 working child psychiatrists exist at the moment, versus a need of close to 30,000.

As the population ages, doctors specializing in geriatric psychiatry are failing to match need, adds Dr. Chris Callohan, director of the Center for Aging Research at the IU School of Medicine.

Ironically, reasons for these shortages include that doctors themselves are aging. A recent study found that more than 60 percent of psychiatrists completed their training more than 21 years ago and that only 32 percent of psychiatrists are younger than 45.

Callohan adds that premed students also aren’t finding psychiatry the most attractive option compared to other arenas. Average salaries of psychiatrists are about a third of other doctor incomes.

Rounding out the shortages are federal funding cuts that have led to fewer residency spots at schools and fewer training programs at hospitals for psychiatrists-to-be.

“There are plenty of people to be seen, that’s for sure,” Schmetzer says. “My greatest fear is my generation, the Baby Boomer one, filled all those extra slots. (Retirements) are going to leave an awful lot of openings.”

The dilemma of doctor scarcity is also met with the descending slope of community mental health facilities across the nation.

In the last few years, Indiana has faced its share of facility reorganizations because of financial trouble and tight budgets. This includes last year’s merger of Hamilton County mental-health services provider BehaviorCorp. and Anderson-based Center for Mental Health Inc.

The new nonprofit corporation, Aspire Indiana, serves residents in Madison, Hamilton, Boone and northern Marion counties.

Two more Indiana mental health facilities – the Center for Behavioral Health and Quinco Behavioral Health systems – were also recently bought out by Centerstone, Tennessee’s largest behavioral health care provider, according to business reports. The combined organizations now have more than 120 locations in Indiana and Tennessee.

And Madison Center in South Bend is experiencing serious transition because of ongoing financial issues. Madison officials insist, however, the center will not be closing anytime soon.

Fill-in doctors

With more mental health facilities struggling to survive, some, like Madison Center, are turning to alternatives to permanent doctors, at least temporarily.

Locum tenens, which in Latin essentially means “placeholder,” are temporary physicians contracted to provide fill-in services.

The locum tenens physician industry has grown by leaps and bounds over the last 10 years, according to Staff Care, one of the largest locum tenens contracting companies in the country.

In 2002, about 28,000 doctors were working on a locum tenens basis for the agency, said Staff Care spokesman Phillip Miller. That number rose to 37,000 in 2008.

Opinions on whether locum tenens are beneficial in the long term are mixed.

Schmetzer says temp doctors can be a good idea for rural areas where psychiatrists are hard to come by and access to care is significantly reduced.

But like many of the doctors interviewed for this story, he worries about continuity of care.

Patients benefit from doctors familiar with their history, he said, adding that those with persistent mental illness especially don’t deal well with change.

Trivedi agrees.

“Patients in psychiatry talk about the most detailed part of their lives,” he said. “You develop rapport with your doctor. That’s difficult if they’re leaving in a month.”

Miller, however, argues that locum tenens are far better than the alternative, which is “not to have a doctor,” and that the physicians still provide top quality care.

Credential requirements for locum tenens have become stricter over the last five years, Miller said, along with reviewing their licenses and malpractice records.

Miller said locum tenens also benefit doctors who are dissatisfied with traditional practices and dealing with processes such as insurance claims and fighting for payment reimbursement.

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

New device, less pain

By Alicia Gallegos
Tribune Staff Writer

Source: news
Wednesday,February 25, 2009
Edition: mich, , Page D1

SOUTH BEND — After performing hundreds of knee replacement surgeries, Dr. Ron Clark, a South Bend Clinic orthopedic surgeon, was troubled by the stories he heard from many patients.

Although most told him the surgery ultimately had changed their lives for the better, they also said the experience had been one of the most painful.

Clark was determined to find a way patients could have less pain after surgery and recover more quickly once they were home. Now, after years of developing a new surgical device, the doctor seems to have done just that.

The method centers on a new implant used during knee replacements that allows for smaller incisions, Clark explained during a recent interview. Incisions in traditional surgeries are about four inches long, he said, while his new procedure allows for an incision between 11/2 inch and 2 inches.

Historically, surgeons have put cement on the implant and pushed the cement against bone during the surgery, according to Clark.

The new implant has cement channels built into the device, so that doctors can attach a cement syringe to the implant and inject liquid cement directly into the implant, Clark explains. The liquid cement then flows to the bone, allowing it to hold better and bond more strongly.

Right now, Clark said, he is the only doctor in the country performing the new surgery, but not for long. He recently gave a surgical demonstration and will teach the technique during a conference later this month.

Not everyone, however, believed in Clark’s device when he first came up with the idea.

Rocky road to success

In 2005, when Clark applied for funding from the Indiana 21st Century Research and Technology Fund, to further develop his idea, he said he was rejected. A panel expert called Clark’s suggestion a “waste of time.”

So Clark employed a patent attorney and soon after founded an enterprise called Valpo Orthopedic Technologies, in Warsaw, to help him work on the design. In 2008, the new implant was approved by the Food and Drug Administration. Since December, the doctor has performed five successful surgeries with the new device, including one on Edwardsburg resident Barb Stitt.

The 45-year-old woman has degenerative joint disease along with severe arthritis, and had had five prior knee surgeries. Her throbbing knees made even trips to the grocery or gardening limited, Stitt said, and she often had to rest as soon as she was home from work.

“I walked like a 90-year-old lady,” she said. “I had a terrible limp.”

Stitt’s left knee eventually became so weak, she said, that nothing was left for her to do but have knee replacement surgery. Stitt, a South Bend Clinic allergy nurse, knew Clark and had heard about the new surgery. As soon as it was FDA-approved, Stitt said, she told the doctor, “Sign me up!” She had the surgery in January.

The operation took longer than expected, Stitt said, because of glue that did not completely adhere to the implant the first time. The second round, the implant stuck.

Clark said the complication came not from the implant, but from the surgical technique, which has been modified some since Stitt’s surgery.

As for recovery, Stitt was elated to have a much easier experience this time around. In the past, she had spent as long as six weeks recovering.

“I was able to bear weight the night of the surgery,” she said. “I healed up pretty well.” The nurse was also back to work after only a week.

“I would tell people this is an excellent procedure to have done,” Stitt said.

Another advantage, according to Clark, is cost. Traditional knee replacement runs about $30,000, compared with $10,000 for the new surgery, because less bone is removed, less bleeding occurs and physical therapy time is decreased.

The implants, Clark said, also should last longer than traditional replacements — remaining about 10 years longer than traditional implants.

Clark said an average of 5 percent of patients who receive uni-compartment knee surgery, in which only one portion of the knee is operated on, generally need a second surgery.

With the new device, that second surgery likely will come further down the road and be more bearable if it does happen, Clark said.

Stitt says she knows that eventually, she will need complete knee replacement surgery, but she believes her recent surgery has given her plenty of time before that happens.

“It’s improving every day,” she said. “I went shopping last weekend. I feel a lot better.”

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

How valid is a will?

By Alicia Gallegos
Tribune Staff Writer

Source: news
Monday,August 24, 2009
Edition: mich, , Page A1

SOUTH BEND — It’s a legal contract no one really likes to think about going into effect.

The document where you inscribe your final wishes, listing to whom you bequest your worldly possessions and exactly how much to bestow upon them.

But though the process of writing a will seems a necessary evil, challenges to the age-old practice remain.

Recently, will conflicts have become the subject of heated lawsuits locally and nationally, sparking concerns about the validity of a person’s last testament.

Exactly how much is a will worth when the document can later be debated?

Battling beneficiaries also raise questions about the mental competency of a will’s creator and the rules in place to prevent them from unfair influence.

“When a case is contested,” says Alan F. Rothschild Jr. “It can be emotionally and financially draining.”

That’s why Rothschild, head of the Trust and Estate Division of the American Bar Association, and other law experts warn residents to take precautions.

Seeing the signs for potential will wars and planning ahead could work to protect your will and curb the likelihood of conflict after your death.

Unstable mind?

For years, 67-year-old Jerome L. Jeffers of Elkhart struggled with mental illness, according to family members and court documents.

The former patent attorney for Bayer Corp. had been diagnosed with a major depressive disorder as far back as 1991, court documents state, exhibiting mood swings and panic attacks, and trying to commit suicide.

In 2008, the married father of two reportedly started showing extreme manic behavior. Jeffers was arrested for public intoxication, compulsively bought a car, and could no longer manage bills, according to court documents.

Although he received sporadic treatment over the years, his volatile behavior eventually led to the dissolving of his 44-year marriage. Jerome and Janice Jeffers divorced in June 2008.

On Sept. 3 of that year, Jeffers admitted himself into the psychiatric ward of a Wisconsin hospital, court documents indicate, where he had abruptly moved. He discharged himself Sept. 8, 2008.

Seven days later he called his former wife and told her he planned to take an overdose of pills, according to documents.

Shortly afterward, Jeffers committed suicide by drowning in a Wisconsin lake.

Only after his death did family members learn that Jeffers had recently and drastically altered his will.

The original document, established in 2003, had listed his then-wife as the 100 percent primary beneficiary of his accounts, and his two adult daughters as 50 percent contingent beneficiaries, documents state.

But on July 11, 2008 – two months before his death – Jeffers changed those terms, giving 75 percent of his savings to the American Red Cross and 12.5 percent each to his daughters. The combined value in Jeffers’ two accounts, court documents say, was more than $1.2 million.

The will change has led to a recently filed federal lawsuit by Janice Jeffers and her daughters, Kelly and Kristen Jeffers, against The American Red Cross.

When reached by phone, Janice Jeffers said she believes her husband was not in his right mind when he made changes to the will. He had never had close ties to The American Red Cross, she said, other than sometimes giving blood to the agency.

Janice Jeffers said the Red Cross refused a mediation that might allow for a more fair distribution of the funds to her daughters. The family is also questioning if the will was changed with the proper number of witnesses.

A representative for the American Red Cross said the agency could not comment on pending legal matters. Fidelity Brokerage Services officials, also named as defendants in the suit, declined to comment as well.

Uncommon conflict

The Jeffers case is far from the only will dispute that has landed in court.

A string of recent will battles involving celebrities like Michael Jackson, James Brown and Anna Nicole Smith also have brought the subject of to the forefront.

Locally, there is also the recent case of the late Dr. Philip Gabriele, whose brother-in-law has asked a court to revoke the doctor’s will, claiming a depressed Gabriele was being unfairly influenced when he penned the document.

Gabriele and his wife, Marcella, were indicted in federal court for malpractice in June and scheduled to be arraigned the day they were found dead in an apparent murder-suicide.

Gabriele wrote the will just days before he died, giving purported best friend Susan Manuszak 75 percent of his gross estate and his mother 25 percent.

But despite all the publicity, Rothschild says, contested wills are not typical.

“In my 25 years practicing law, I would say less than one percent of wills are contested,” he said.

Local estate expert Richard B. Urda Jr., attorney and president of Urda Professional Corp. in South Bend, agrees. The disputes are “relatively rare,” says Urda, who is also a fellow with The American College of Trust and Estate Counsel.

If a will is contested, however, Urda points to three common assertions, including: that proper will procedure was not followed, that the client had decreased mental competency, or that someone exerted “undue influence” during the time of the will.

Childless couples also have a greater risk of having their wills challenged because of the broader mix of possible beneficiaries, Rothschild says.

But both experts detail some ways to prevent a will dispute, and they say it’s never too late to implement them.

Dissolving disputes

The tools are used to catch criminals, to provide building safety, and also, in recent times, to ensure will security.

They are videotapes.

Clients have had the ability to have their interactions with attorneys and estate planners recorded for years, Urda says, based on Indiana statute. A person can easily ask to have their will-signing recorded and kept for evidence.

Residents also have the option of a revocable trust, which they can put funds into. Revocable trusts in many states are much more difficult to challenge than a will, according to experts.

As for issues of mental competency, Rothschild believes that attorneys have a certain responsibility to look out for their clients, especially if something doesn’t seem right.

“I feel some personal and professional obligation to not proceed to do something if I think the person does not fully understand what I’m doing,” Rothschild said.

Asking a client additional questions or speaking further with witnesses might be necessary to be certain a client is cognizant, Rothschild said.

Urda adds that it might be warranted to ask for a family physician’s opinion about a client’s mental state if concerns arise.

And don’t forget to speak up.

If you have plans to give money to a certain charity or to significantly change your will, Rothschild says you need to let family members know.

“I think the risk of (will disputes) increases,” says Rothschild. “when it’s a surprise to people.”

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

Did flu shot injure arm?

By Alicia Gallegos
Tribune Staff Writer

Source: news
Friday,March 13, 2009
Edition: mich, , Page A1

SOUTH BEND — With the growing spotlight on the influenza virus, it seems to make sense that many pharmacies have joined medical centers in offering flu prevention.

Signs for free shot clinics and discounted vaccinations are a common sight in local stores come flu season. But concerns exist within the medical community about the qualifications behind those giving out these vaccinations.

A South Bend woman’s recent experience receiving a flu shot appears to highlight these worries.

Lynne Rectenwal has filed a civil lawsuit against Walgreens at 1351 N. Ironwood Drive, claiming that a flu shot she received there in October was injected at the wrong spot, leading to possible permanent arm damage.

Rectenwal declined to be interviewed for this article, but her lawyer, Jeff Stesiak, explained that their contention is that the pharmacist giving the shot aimed it too high on Rectenwal’s arm and into her bone.

“It caused serious injury,” Stesiak said. “She’s been to an orthopedic surgeon and (she) could have lasting effects.”

Walgreens spokeswoman Vivika Vergara said the company was aware of the situation but could not comment on the specific case.

But during this flu season, Vergara said more than 1 million flu shots have been given out nationally at Walgreens pharmacies, administered by pharmacists, third-party nurses and nurse practitioners.

“These health professionals were all certified and trained to administer the flu vaccine,” she said in an e-mail.

Rectenwal suffered significant pain immediately after receiving the vaccine, Stesiak said, and afterward visited a doctor.

An MRI found the shot had been given incorrectly, he said, and a doctor called the Walgreens store to speak with an official about the damage. But Stesiak says the pharmacist denied giving the shot improperly.

The flu-shot related case is not the first Stesiak says he has handled. A similar one related to a patient who had had an adverse reaction after receiving a vaccine, he said.

Health experts say these types of risks make them question the people behind the syringe at pharmacies and whether their training is enough.

Pharmacy officials, however, believe they are plenty qualified to give out the shots, and not only that, but that pharmacies stepping up to provide vaccines is a positive step toward greater access to health care.

Ready, aim, fire

The process of giving a shot might not seem difficult, says South Bend Clinic attorney and nurse Daniel Stephens.

“It sounds pretty simple: You take out a needle and stick someone,” he says. “But it’s not. It’s much more complicated.”

Those giving vaccines must be acutely aware of tissue structure and muscle depth, he explains, adding that a miscalculation could lead to infection or a possible sore at the injection site.

“Some medications are designed to go into muscle,” Stephens said. “If you inject into fat, that’s going to cause a bad reaction.”

The attorney, who has 25 years of nursing experience and now instructs new nurses, says in his opinion, injections should be left to the experts.

“Not only do nurses perform injections frequently, they are also trained in various methods of needle placement,” he says. “You can have someone inject you who occasionally gives a few shots a year, or you can have a true professional do it.”

Margaret Tomecki, a spokeswoman for the American Pharmacy Association, argues that immunization training programs for pharmacists have been developed for years and that adverse reactions to shots in pharmacies are rare.

Tomecki says the APhA recommends pharmacists not only undergo immunization training but also CPR certification.

Other medical experts, like Dr. Jesse Hsieh, a South Bend Clinic family medicine physician, sees both pros and cons to each argument.

Doctors want to see as many people immunized as possible, Hsieh said, adding that at times, stores such as Walgreens and Wal-Mart actually have greater supplies of vaccine than doctors’ offices.

On the other hand, Hsieh agreed that concerns remain about possible allergic or adverse reactions.

“I would like to make sure the person giving my patient a shot has the approved training,” he said.

Right now, 49 states allow pharmacists to give vaccines, according to Tomecki, although states differ on what types they can provide and the specific training required. New York was one of the latest states to allow pharmacists to give shots.

Legislation in the state had been stymied for years because of liability concerns by nurses and doctors, according to national reports.

In Indiana, a new set of rules for the practice has also just been mandated.

New enforcements

Historically, Indiana pharmacists have been allowed to administer flu vaccinations by a physician’s order, according to Marty Allain, director of the Indiana Board of Pharmacy.

Beginning in July 2007, they could give them as long as they were following a physician’s standing protocol, he said.

Best training practices were offered as guidelines by the board, but Allain said until 2009 none had been set in place that were able to be enforced.

The new Indiana administrative code on pharmacist immunization education includes that they must complete an immunization course approved by entities such as the Centers for Disease Control and Prevention, be certified in CPR, know appropriate injection sites and dosage, and be versed in management of adverse effects, among other things.

Allain said pharmacies offering vaccinations must also be licensed and are subject to inspection or investigation.

To his knowledge, the board director said he knows of no pharmacies in Indiana where complaints have been filed with the board for improper administering of flu shots.

Regardless of differing views on pharmacists giving out shots, the vaccinations are likely just the beginning of more routine treatments being offered at places other than doctors’ offices.

“I think we’re going to run across it more and more,” Hsieh said. “This might be the tip of the iceberg.”

Tomecki adds that the practice ultimately means physicians and pharmacists both keeping more people healthy.

“There’s many patients out there,” she said. “Sometimes patients fall through the loops of health care. It’s up to us, working together as a team.”

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368

Doctors note rise in uninsured, indigent patients

By Alicia Gallegos Tribune Staff Writer Source: news Sunday,March 21, 2010 Edition: mich, , Page A1

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SOUTH BEND — More than three months after Saint Joseph Regional Medical Center’s highly publicized move to a new building in Mishawaka, medical officials say a burden is growing in the city they left behind.

According to officials and recent data:

* A significantly higher number of patients are heading to the Memorial Emergency Room for treatment, many of whom are indigent and lack the transportation needed to go to Saint Joseph.

* The number of ambulances racing to Memorial has increased as more patients request the “closest” hospital.

* The pool of on-call doctors helping at Memorial is shrinking as more physicians opt to serve shifts at only one hospital.

Saint Joseph Regional Medical Center has previously said it was in no way abandoning its mission of caring for the poor and underserved in moving to a bigger and more efficient facility in Mishawaka.

But before the move, some health-care advocates voiced concern about potentially longer waits at Memorial and inner-city residents lacking the transportation to the new hospital.

Now, those worries seem to have become reality.

“Patients from South Bend are showing up here in much larger numbers,” said Dr. Steven Spilger, a Memorial physician and ER director. “We have a much larger number of unassigned patients. … It’s stressing the system somewhat.”

In response to questions about the recent developments, medical center spokesman Michael Stack said in an e-mail that although the center has moved, “We have not moved the higher volume, more widely used outpatient practices or services that deliver care to the populations in need. We have extended locations for primary care, as well as hours that physician offices are open.”

He also pointed to the number of clinics the hospital still operates in South Bend and surrounding areas, including the Sister Maura Brannick Health Center, Family Medicine Center and Bendix Family Physicians.

Displaced patients

On a recent evening in Memorial’s ER, more than 30 patients linger in the waiting room, some holding ice packs to their heads or sitting in wheelchairs.

“I’ve been here all day!” a voice bellows from one end of the room. It comes from a 15-year-old girl who says she is having severe back and leg pain and is still waiting to be seen after arriving at 2 p.m. It’s now close to 6.

The teenager’s mother, Carmelita Martin of South Bend, says she is having the same symptoms as her daughter. Martin used to go to St. Joseph Regional Medical Center, she says, adding that ER patients were usually seen faster there.

“I hate that they moved,” Martin said. “You go to what’s closer.”

Across the room is an older man appearing distraught and holding his head in his hand. He’s been waiting three hours, he says, but he points to another family sitting next to him: “They’ve been waiting five hours.”

The mother beside him nods. Her 20-year-old daughter has been having chest pains, she explains. They arrived at noon.

The assembly of patients make up an additional 13 percent increase in volume in the Memorial ER in the last few months, according to hospital data.

Hospital spokeswoman Diane Stover cited several possible reasons for the rise including a busy flu season, the poor economy and the St. Joe move.

Emergency room physician Dr. Richard Seall said the increase may not seem that high, but it’s definitely felt by staff, adding that the ER has become busier as months have gone by.

“We’re seeing patients who haven’t been to Memorial who don’t want to go all the way to Mishawaka,” he said. “A lot of people don’t have insurance and don’t have doctors. We provide them basic care.”

Spilger said one reason contributing to the rise relates to the Indiana Health Center on Western Avenue that primarily treats poor, uninsured patients. Patients from the center used to be split between Memorial and St. Joe, Spilger said, but now Memorial “seems to be getting them all.”Ambulance service statistics reflect the fact that more residents are requesting they be taken to Memorial.

Previously, ambulances went to Memorial about 60 percent of the time and St. Joseph about 40 percent, according to Steve Cox, director of EMS for the South Bend Fire Department.

Numbers now show that percentage has tilted to about 80 percent Memorial and 20 percent St. Joseph, Cox said.

The EMS director said time and convenience are the most common reasons patients list for wanting to go to Memorial. The decision is entirely up to the patient, he explained, unless, of course, the resident is critical and in need of Memorial’s higher-level trauma services.

Cox stressed that the numbers only show the first few months since St. Joseph’s move and that a better picture will likely develop after more time has gone by.

Meanwhile, Mishawaka ambulances have increased their service to St. Joseph Regional Medical Center, according to officials, dropping patients off more quickly and improving turn-around times.

“The new hospital has proven to be a real asset to the Granger community and Clay Township,” said Fire Chief John Vance with Clay-Harris Fire Territory.

Lt. Kerry Hershberger with Mishawaka Fire said his department’s ambulance unit is also going to St. Joe more often and agreed the move has made a significant difference in turn-around times.

St. Joe efforts

Stack said St. Joseph continues its efforts to reach out, adding that a Transpo bus route has been extended to the hospital to accommodate patients in South Bend.

“We constantly plan on how to serve the community however we can,” Stack said. “We work with all those who are in need of our services so that they can benefit from the high quality health care services we provide for all populations living in the communities we serve.”

Stack would not address a reporter’s question about whether the trend of more poor patients headed to Memorial’s ER is concerning, saying only, “The answer we’ve provided is the answer to your question.”

When asked whether the hospital could provide any current geographical data about patients coming into the new medical center, Stack replied: “Our hospital is here to serve the over one million people in our market areas of 8 counties, including generations of families who have come to rely on us for exceptional quality and compassionate, faith-based care for over 125 years. Our patients have come, and are continuing to come, from all over Michiana.”

Stack acknowledged later that demographic information is collected and used for marketing purposes, but he would not further address the issue.

Fewer doctors to call on

As the number of patients seeking help at Memorial has risen, the number of outside doctors providing services there has dropped.

Qualified physicians can choose hospitals for which they can be on call. And historically, said Dr. Jesse Hsieh, doctors in the community frequently worked at both hospitals when needed.

But since the move, that number is diminishing as more on-call doctors are choosing only to go to St. Joseph, said Hsieh, family practitioner and board president of the South Bend Clinic.

Many docs don’t want to make the extra drive or are concerned about being too far from calls if they’re already at one hospital. Physicians in Memorial’s ER agreed they’ve seen this shift in on-call help.

The shrinking pool means patients who formerly had St. Joseph primary care physicians are showing up at Memorial without their doctors available.

South Bend Clinic physicians, meanwhile, are still serving at both hospitals and will continue to do so, Hsieh said, but the majority have noticed they are being called to Memorial more often since the move.

When asked about this issue, Stack said in his e-mail response: “SJRMC provides a physician-friendly environment featuring the greatest in medical technology and workflow convenience. We are very proud that Michiana physicians want to practice their quality healthcare in our new facility.”

During a followup phone call, Stack said he had not heard about more St. Joe doctors opting out of on-call stints at Memorial.

Soothing the increase

Recently, Seall said Memorial has added staff and more shifts to keep up with the inflow of patients.

At least one more nurse per shift has been added, he said, and two new physicians were just hired. They will start soon.

Seall and other medical officials say they don’t believe the swell of patients coming into Memorial will decline any time soon.

“Unless something changes, (especially) for those without health care, people who don’t have access to primary care physicians,” Seall said, “we’re their only option.”

Staff writer Alicia Gallegos: agallegos@sbtinfo.com (574) 235-6368